Provider Demographics
NPI:1952528028
Name:BUCKLEY, WALTER S III (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:S
Last Name:BUCKLEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 HAMPSHIRE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2504
Mailing Address - Country:US
Mailing Address - Phone:805-497-3736
Mailing Address - Fax:
Practice Address - Street 1:8555 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4014
Practice Address - Country:US
Practice Address - Phone:562-923-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG211302086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41192Medicare UPIN